During our conversation, Kathleen McLaughin, author of Blood Money: The Story of Life, Death, and Profit Inside America's Blood Industry and award-winning journalist, tells a story. Last fall, she was speaking with her dad about the book at a university football game. His generation didn't do this—sell plasma—she said, because the practice didn't exist then. "He said to me, is it really as common as you think it is?" she recalls. "I swear to God, I got up and went to the bathroom at the football stadium, [and] there was a huge ad on the wall, ‘part time, pays well,’ and it was an ad for selling plasma."

At once an exposé and a profoundly personal story, Blood Money examines the exploitative human blood plasma industry, including the fact that as many as 20 million people might be selling plasma in a given year. As McLaughlin writes, America’s plasma industry “consists of a network of hundreds of plasma extraction centers, deliberately built in economically disadvantaged neighborhoods, towns, and cities,” taking advantage of America’s racial and economic inequities; places where, she continues, “companies know people need money and might do something a little unpleasant to get it.” For reference, McLaughlin explains that if you donate plasma at the Red Cross—which does not pay—they limit you to donating 13 times per year. If you donate at a for-profit center, you can donate 104 times a year.

McLaughlin’s personal writing is as stirring and urgent as her reporting (she has a rare immune disease that demands treatment with medicine made from human blood plasma). But at its core, Blood Money is a gripping book about the impact of deep economic inequality and a frayed social safety net. It asks an urgent question: as a society, is this who we want to be?

McLaughlin spoke with Esquire about all this and more. This conversation has been edited for length and clarity.

ESQUIRE: As you reported this book, were there moments where what you found was different than what you thought you would find?

KATHLEEN MCLAUGHLIN: The whole project was a little different than what I thought I would find. As soon as I started interviewing people who donate or sell plasma, I realized that it was just completely a story about how frayed our economic safety net is.

This is the thing that we don't like to acknowledge, as journalists: I was doing all this reporting around this issue because it was personal to me. I think most journalists do that in one way or another. But I initially thought, “Oh, well, this is probably going to be a book about this devastating AIDS catastrophe that happened in China.” I felt like it was a super important story. But I managed to meet the woman, Dr. Wang Shuping, who blew the whistle on the AIDS crisis in China. She lived in Salt Lake City, which is not that far from me. We spent a few days together, and the last place she took me to was a plasma donation center in Salt Lake. I was like, I came here to talk to her about China. What are we doing here? Then it clicked: she thinks we’re setting up a system similar to what she saw in China, and she's completely freaked out by it. She's the one that really sparked it for me, because I didn't understand the connection between the two places. I had just moved back to the States, so I missed the part of things where China had this dystopian thing where they were going to create something called the plasma economy. The United States actually did it.

At one point in the book, you go semi-undercover, interviewing for a job at a plasma extraction center. How did that inform this piece of the reporting?

There was no other way for me to get into the plasma center. After all of this reporting, and especially after going into that plasma center, I don't think this industry itself is evil. I think that people who work in this industry care about their jobs, and they care about other people. I think it's just a manifestation of a broken economic system.

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The way that the employees treated the donors was very heartening to me; they were quite kind, the place was incredibly clean, and it was really well-run. Before I went in there, I had donors tell me that they felt like dairy cows being milked, and when I went into the plasma center, I was like, “Oh, I get it now.” It's almost like a science fiction movie, to see people strapped up to these machines and their fluids are being extracted. It gave me a glimpse into something I would not have seen otherwise.

I was shocked to find that what they wanted to know the most about was how I would deal with customer service, so I told them about my previous work in restaurants and in retail. I have absolutely zero experience in anything to do with medicine or sticking people with a needle, but they didn't seem to mind. If you don't have a lot of extra money, you're not making donations to charities on a regular basis, but you can do this and get paid for it. I don't want to underplay that: some people really do feel like they're giving back and they are.

That came through in the book. It’s not always about getting by; it’s about being able to breathe a bit easier.

It’s a cushion for a lot of people. This practice is so stigmatized, I think, because we stigmatize poverty in the US. People assume that the only people who do this are super poor. It's just not true. And even if it were, why do we stigmatize poverty in this way? If you go to the Red Cross and donate blood, you’ll tell everyone about that; you're giving back. I’ve talked to so many people, even after writing the book, who have told me that they sell plasma, and they've never told their family because it's stigmatized. I think it's because we think so poorly of poor people that anything associated with poverty is not something most people want to be linked with.

When you were studying this map of the extraction centers, what brought you to certain locations?

If you look at where the centers are, you can map the economic fault lines of the country. You can really pick out places where inequality is a problem and growing. You will find a lot more of these in the Rust Belt’s former industrial cities. Ohio and Michigan. You find a growing number of them in the Mountain West, where inequality is just soaring off the charts. And then, what they call the most productive part of the industry in court documents, is the US-Mexico border, where for many years, Mexicans have been coming over to sell their plasma in the US.

I chose the places I did because they're all different. So the town I went to in Idaho is a college town, which is a super common place for people to be selling plasma. Rexburg is predominantly Mormon and predominantly white, with a huge university. I went to Flint because everyone knows about the damage that corporations have inflicted on that city, but it's also different demographically: it's a majority Black city. They have fewer than 100,000 people, but six plasma centers, which is insane. I went to El Paso and the border because that’s the most productive place, and it's also predominantly Mexican people. I was looking to find different places that had different demographics to show that this is really happening everywhere.

You mention the Mountain West, and how, historically, it hadn’t been an ideal place for this industry—but that’s changing. What does that expansion tell us?

Montana, where I live, has the highest growing rate of economic inequality of any state in the country. You have people who are working for local wages, and then you have a massive influx of people who are coming in to do remote work, or buying up second and third homes and not actually living here full-time. I talked to someone the other day who was considering returning to selling plasma, because their housing costs have gone up so much. So there are a number of places that have opened in the Mountain West. The population is growing and inequality is growing, so we're definitely seeing more people who need extra money.

I was thinking about the ridiculous red state/blue state discourse. Does that factor into the lack of notice of this industry's place in the American economy?

Oh, 100%, no doubt about it. National media is mostly based in a couple of coastal cities where selling plasma is not that widespread. Place is incredibly important in this. There’s some coverage of it now and again, but it's usually tied into a different story. I don't think that anyone has really stepped back and looked at how big it is, and how it's become completely woven into our society as part of a lot of people's household budgets.

You write that college students are a primary target for plasma companies. How have factors around higher education reinforced this?

There's this expectation that everyone has to go to and get a university education, but we don't provide people with the means to pay for it. It seems to me that the cost of living is the primary reason that college students do this. I've talked to students who are doing it for groceries, who are doing it for books—books is a big one. Having a part time job while you're studying full time is really hard. And if you can sell plasma a couple of times a week and not have to work 30 hours a week while you're going to school, that’s huge.

Somewhat related is this idea of youth—the preserving of youth and recapturing of youth via blood. It made me think about how this country exploits youth while glorifying its attributes. Did that come up for you while reporting?

I think that was really a thread through all of it. Humans have been obsessed with the idea of older people consuming young blood to restore their youth, or to live longer, or to live forever. These ideas of immortality and blood, and youthfulness, the fountain of youth tied with blood—it's all throughout art and literature. For centuries, we've had this obsession. You look at these blood experiments [in] Silicon Valley or this drive to recapture youth through whatever means if you have great wealth; it's just an extension of things we’ve been doing forever. It’s always based on exploitation or consumption of youth, but also idolizing it. People really want to recapture their own youth without having appropriate care or concern for young people.

You did not approach this as a neutral observer–you write about your own health. How did that feel?

It's absolutely terrifying to do, because this is something that I've hidden from most people for 20 years. I don't talk about it, in large part because our society discriminates against people with any kind of physical weakness, or illness, or disability. I don't generally like to write about myself to begin with. But at the same time, there was no other way to tell this story. I am so personally connected to all of this, and I benefit from it, but I am so conflicted about all of it.

The depth of reporting and interviews in this book was extraordinary. How did you decide who to include?

My goal initially was to talk to 100 plasma donors, in different places. In the end, I went a lot longer on a couple of people that I interviewed—the journalist in the Midwest, and Emily in Texas—because I felt like their stories told a deeper story. What I would do is go to a plasma center and stand outside, almost like I was taking a survey, and just tell people what I was doing, then chat with them. I wish I had spent a little more time with the teacher, because teachers are a big subset of the plasma-selling population. Doing the reporting and talking to people was like, “I actually just need to show how common this is, and how many different kinds of people with different experiences do this, because we're so bad at taking care of people economically in this country.”

I wanted to ask you specifically about Emily, a single mom who was in debt because of traffic tickets and fines, and was selling plasma. What did her story encapsulate for you?

In a nutshell, it was really a story of how we punish people for being broke in this country. You can't catch a break. She was very interesting to me because she knew herself, and she really wanted to improve her life. She was going to college; she had these little kids that she adored. But she said something to me two times in our interviews, which just broke my heart. She said, “I would sell a kidney if I could.” She really meant that. I don't think we, as a society, as a country, have ever stood back and said, “Are we okay with being a society where people feel compelled to sell pieces of themselves just to make ends meet?”

Based on your reporting in this project, what do you hope people take away?

It's always been a very uncomfortable situation for me, because I feel like I benefit from other people's difficulties. The fact that people feel compelled to sell plasma twice a week just feels like too much. Outside of the plasma industry itself, I hope for a greater recognition from policymakers, from journalists, from everyone else, that a lot of places in this country are broken and getting worse, and inequality is actually causing people to make really difficult decisions that they shouldn't have to make.

I think what we really need to talk about are basic things like affordable college, affordable housing, universal health care—all the things that we don't have that cause people to be broke. The industry, to me, is just a symptom of all these other problems. The way things stand right now—the part that is spooky and creepy—is that we have let people fall through the cracks so far that this is what they have left.

What do you want readers to know about this book?

I want people to stand back and take a deeper look at how we got to this point. Are we okay with it, as a society, that we've built this system where a certain number of Americans have to do this to get by? I hope people take away that we need to be more thoughtful about how we treat the most vulnerable members of our societies. If most people think about it, they wouldn't be okay. I’m hoping people step back and say, “Hey, wait a minute. This is who we are. Is this who we want to be?”